Update on Cutaneous Manifestations

170 views 2 04/23/2020 05/19/2020

 

  1. Cutaneous manifestations are reported in many countries. However,  due to the current pandemic, several case reports are being published rapidly, which raises questions about the scientific validity of these articles.   Indeed, several articles have no histopathological evidence to correlate with clinical diagnosis. 
  2. Currently, there are no cutaneous manifestations specific to COVID-19, but there are certainly some skin lesions in a subgroup of patients. 
  3. Cutaneous manifestations are classified as non-specific viral cutaneous manifestations and vascular cutaneous manifestations.
  4. Non-specific cutaneous manifestations include:
    • Urticaria (Henri D. et al. and Quintana-Castanado L. et al.)
    • Exanthema (Najarian D. J. et al.)
    • Kawasaki disease (KD) : Jones V.G. et al reported a 6 month-old infant with fulfillment of clinical criteria for the diagnosis of KD and a positive test.  Clinicians have described high number of patients presenting with features of KD (complete or partial) or a Kawasaki-like illness, also called multi-system inflammatory syndrome. The exact association with COVID-19 remains unknown.
    • Varicella-like exanthema (Marzano A.V. et al. described 22 cases): According to Casas C. G. et al, this could be an early finding. 
    • Petechial eruption (Joob B. et al. and Diaz-Guimaraens B. et al.)
    • Erythema multiforme-like (Rodríguez-Jiménez P. et al. and Jimenez-Cauhe J. et al.)
    • Other case reports include:  SDRIFE (Mahé A. et al.), papules on heels (Esténabez A. et al.), facial lesions (Hoenig L. J. et al), vesicular rash (Fernandez-Nieto D. et al.), digitate papulosquamous eruption (Sanchez A. et al.) and oral vesiculobullous lesions (Martín Carreras-Presas C. et al.). 
  1. Vascular cutaneous manifestations include:
    • Critically ill patient: 
      • Acro-ischemia (gangrene in the critically ill) (Zhang Y. et al.)
      • Livedo racemosa, retiform purpura (Magro C. et al. and Bouaziz J.D. et al.)
      • This could be a sign of intravascular and multiorgan clotting, which could change the therapeutic conduct.
    • Acral lesions presenting either as acro-ischemic lesions (Mazzota F et al.) or perniosis (chilblain, pseudo-chilblain) (Alramtham A. et al., Fernandez-Nieto D. et al., Piccolo V. et al., Bouaziz J.D. et al., Kolivras A. et al. and the « Société Française de Dermatologie »)
    • Transient livedo reticularis (Manalo I.F. et al., Bouaziz J.D. et al.)
  1. To this day, perniosis has been reported by many physicians as a late findings.  
  1. Dr S. Recalcati first reported cutaneous manifestations in 20.4% of patients, mostly exanthematous rash, but also widespread urticaria and varicella-like vesicles. 
  1. Casas C.G. et al. provided a classification of the possible cutaneous manifestations associated with COVID-19 based on a rapid prospective study.
  2. There are still several questions that remain unanswered including the significance of cutaneous lesions in the management of patients.

 

Sources : 

  1. Alramthan, A. and Aldaraji, W. (April 17, 2020). A case of COVID-19 presenting in clinical picture resembling chilblains disease. First report from the Middle East. Clinical and Experimental Dermatology.  https://doi.org/10.1111/ced.14243
  2. American Academy of Dermatology. (April 22, 2020).THE PROFOUND DERMATOLOGICAL MANIFESTATIONS OF COVID-19: PART IV – CUTANEOUS FEATURES. Retrieved from: https://www.aad.org/dw/dw-insights-and-inquiries/2020-archive/april/dermatological-manifestations-covid-19-part-4
  3. Bouaziz J. D., Duong T., Jachiet M. and al. (April 17, 2020). Vascular skin symptoms in COVID-19: A french observational study. Journal of the European Academy of Dermatology and Venereology: JEADV. https://doi.org/10.1111/jdv.16544
  4. Casas C. G., Català A., Hernández G. C., and al. (April 19, 2020). Classification of the cutaneous manifestations of COVID-19: A rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. https://doi.org/10.1111/bjd.19163
  5. Diaz-Guimaraens B., Dominguez-Santas M., Suarez-Valle A., and al. (April 30, 2020). Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatology. https://doi.org/10.1001/jamadermatol.2020.1741
  6. Estébanez A, Pérez-Santiago L, Silva E, and al. (April 15, 2020). Cutaneous manifestations in COVID-19: a new contribution. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16474
  7. Fernandez-Nieto D., Jimenez-Cauhe J., Suarez-Valle A., and al. (April 21, 2020). Characterization of acute acro-ischemic lesions in non-hospitalized patients: A case series of 132 patients during the COVID-19 outbreak. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.04.093
  8. Henry D, Ackerman M, Sancelme E, and al. (April 15, 2020). Urticarial eruption in COVID-19 infection. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16472
  9. Hoenig L. J. and Pereira F. A. (2020) Rash as a Clinical Manifestation of COVID 19 Photographs of a Patient. Clinics in Dermatology. https://doi.org/10.1016/j.clindermatol.2020.04.001 
  10. Institut national d’excellence en santé et en services sociaux (INESSS). (April 22, 2020) COVID-19 et manifestations cutanées. Retrieved from: https://www.inesss.qc.ca/covid-19/presentations-cliniques/manifestations-cutanees.html
  11. Jones V. G., Mills M., Suarez D. and al. (April 7, 2020). COVID-19 and Kawasaki disease: novel virus and novel case. Hosp Pediatr. https://doi.org/10.1542/hpeds.2020-0123
  12. Joob B. and Wiwanitkit V. (March 22, 2020). COVID-19 can present with a rash and be mistaken for dengue. Dermatol. https://doi.org/10.1016/j.jaad.2020.03.036
  13. Kolivras A., Dehavay F., Delplace D., and al. (April 15, 2020). Coronavirus (COVID-19) infection- induced chilblains: a case report with histopathological findings. JAAD Case Reports. https://doi.org/10.1016/j.jdcr.2020.04.011. 
  14. Magro C., Mulvey J. J., Berlin D., and al (April 15, 2020). Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Translational Research: The Journal of Laboratory and Clinical Medicine. https://doi.org/10.1016/j.trsl.2020.04.007
  15. Mahé A., Birckel E., Krieger S., and al. (April 15, 2020). A distinctive skin rash associated with Coronavirus Disease 2019?. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16471
  16. Manalo I.F., Smith M.K., Cheeley J., and al (April 6, 2020) A Dermatologic Manifestation of COVID-19: Transient Livedo Reticularis. Journal of the American Academy of Dermatology.  https://doi.org/10.1016/j.jaad.2020.04.018. 
  17. Martín Carreras-Presas C., Amaro Sánchez J., López-Sánchez A. F., et al ( May 5, 2020). Oral vesiculobullous lesions associated with SARS-CoV-2 infection. Oral Diseases. https://doi.org/10.1111/odi.13382
  18. Mazzotta F. and Troccoli T. (March 2020). ACUTE ACRO-ISCHEMIA IN THE CHILD AT THE TIME OF COVID-19. Dermatologia Pediatrica. https://img.beteve.cat/wp-content/uploads/2020/04/acroischemia-ENG.pdf
  19. Marzano A. V. and Genovese G., Fabbrocini G. et al. (April 16, 2020). Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.04.044
  20. Najarian D. J. (April 14, 2020). Morbilliform Exanthem Associated with COVID-19. JAAD Case Reports. https://doi.org/10.1016/j.jdcr.2020.04.015
  21. Piccolo V., Neri I., Filippeschi C. et al. (April 24, 2020) Chilblain-like lesions during COVID-19 epidemic: A preliminary study on 63 patients. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.16526
  22. Quintana-Castanedo L. and Feito-Rodriguez M., Valero-Lopez I. , et al. (April 29, 2020) Urticarial exanthem as early diagnostic clue for COVID-19 infection. JAAD Case Rep. https://doi.org/10.1016/j.jdcr.2020.04.026
  23. Recalcati, S. (March 26th, 2020). Cutaneous manifestations in COVID-19: a first perspective. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.16387
  24. Sanchez A., Sohier P., Benghanem S., and al. ( April 30, 2020). Digitate Papulosquamous Eruption Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatology. https://doi.org/10.1001/jamadermatol.2020.1704
  25. Société Française de Dermatologie (April 15, 2020). COVID-19 ET LÉSIONS CUTANÉES
    POINT D’ÉTAPE COVIDSKIN DE LA SFD. Retrieved from    : https://evenements-sfd.fr/?mailpoet_router&endpoint=view_in_browser&action=view&data=WzE5NywiNmZmMmE4ZTA4YzIyIiwwLDAsMTQzLDFd
  26. Société Française de Dermatologie (April 28, 2020). COVID-19 ET LÉSIONS CUTANÉES POINT D’ÉTAPE 2 DE L’ENQUÊTE COVIDSKIN DE LA SOCIÉTÉ FRANÇAISE DE DERMATOLOGIE. Retrieved from:https://evenements-sfd.fr/wp-content/uploads/2020/04/point-etape-covidskin-27-04-20.pdf?utm_source=mailpoet&utm_medium=email&utm_campaign=actualites-du-fonds-de-dotation-de-la-sfd_171 
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